Prior to JoMI, Nikita co-founded and was the CTO of http://www.jove.com, the first scientific video journal. He has also co-founded http://fairsetup.com, a platform offering a novel approach to performance management and compensation.

Why Healthcare? I’ve always wanted to impact healthcare, I’ve always wanted to make a difference. Entrepreneurship was a way to have a lot more influence that is proportional to how good a job you do.

Hot Topic that should healthcare leaders agenda: Outcomes

How have you created results by doing things differently? Impact outcomes by creating a bridge to high volume surgeons.

Quality of resources that you use and the ability to deliver care. I urge the physicians to look at what we’re doing and to all administrators to ensure that we have a process to assess the impact of resources as we are purchasing them and really understand the quality of care that you’re able to deliver.

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.

: [00:00:18] Outcomes Rocket listeners welcome back once again to the outcomes Rocket podcast the podcast where we chat with today's most inspiring and successful health care leaders. Today we have an outstanding guest. His name is Nikita Bernstein. He's the CEO and founder at JOMI. That is the Journal of Medical insight The Journal medical insight seeks to improve outcomes through publication of videos of cutting edge and standard of care surgical procedures. Nikita's got a really interesting background. He comes to us from outside of medicine but tons of insights that will help make the system better Nikkita out when I welcome you to the show today.

: [00:00:59] Thanks thanks for having me. I'm flattered and honored by your introduction mature for their insights. But I will certainly try.

: [00:01:07] And so tell me something you know you had a successful career building that your previous company ad Jova and you decided to get into medicine about five years ago. What made you make the switch?

: [00:01:20] It wasn't so much of a switch. I've always wanted to impact healthcare right. Like I've always wanted to make a difference right. Like especially watching my parents emigrate watching everything that's happening really I love the idea of making a difference on something read like something meaningful. So it was very difficult for me to get excited about a corporate gig. So entrepreneurship was a way to have a lot more influence that is proportional to how good a job is if you do a crappy job that no one gives you influence. That's the way it works. And when we started job with Matia he actually invited me. It was his idea. I was the co-founder and CTO of Joe's. The intention was to build something that improves quality of research right it was to solve the reproducibility of experiments. And my idea behind this was that as well would grow eventually we would expand. Unfortunately, Moshe and I both had our heads and not the right place. Got it. There's a lot of things he's very particular character I'm a very particular character he is very good at driving things but from a management perspective we had very different ideas on how a company should be about his ideas very early down my was very bottom up and that in combination with a few other factors triggered a massive disagreement between us so long story short there was no opportunity for us to do improvement of care from a video journal perspective in healthcare.

: [00:02:55] Now that I've been doing this for a while it's a very different beast very different requirements very different operation. There is certainly some overlap you hold can resemble but that's about where the similarities end and after we kind of hit our snags in terms of our relationship and how we run the company with a jolt. I spent about two years developing an idea around how a company should be managed and then put it into the foundation of. So I've always wanted to have impact and quality of care. I did not want to specialize. Being an entrepreneur I feel like an entrepreneur is someone who just doesn't have enough focus to be a search

: [00:03:37] Right. Like I focus that's for sure.

: [00:03:40] Right. And it definitely beats work ethic and to you if you don't have it entrepreneurship that is. But I like creating something that impacts and there are different types of entrepreneurs or entrepreneurs who do a lot of calculation beforehand and they go they raise money they go in a very kind of not necessarily formulaic manner but in a very systematic and smart approach and the risk there is more managed. But the I would argue that value also is limited. I am more of a like oh hey that shiny thing let me give it a shot. So what do I know how do I know how to do a video journal. I also know that there is a problem with healthcare because well who doesn't know that.

: [00:04:21] So speaking of that Nikkita what would you say a hot topic that should be on every medical leaders agenda today and has JOMI addressing that.

: [00:04:28] I think outcomes. This is not meant to placate you or your podcast in any way shape or form. But I was being an outsider. I have a particularly different view on things and looking into the system. I was blown away. I mean what is my expectation my expectation is that I would come into this bastion of ethics and the decisions around care and delivery of care is driven by outcomes driven by data. And that is not what is happening that is not what I'm observing right. Hospitals across the street can talk to each other. You have people in the name of HIPPA compliance things which don't get me started and the decisions should be done based on like what is the probability of success what is the history of success for a particular practitioner for particular cohort of patients. How do I fit into that cohort and really that should be driving things. And what we have is not that at all. I was shocked the fact that it is effectively it feels to me like a combination of expert opinion with very inefficient flow of information. And as a publisher my role is to try to improve the flow of information eventually hopefully. I believe there should be no such thing as marketing. That's right. Certainly in some domains or in some subdomains but where the outcome is a person lives or dies. Marketing should have no plan. That should be all data driven.

: [00:06:00] Yeah you bring up an interesting point right. Like you come into the industry from the outside and you're expecting to see good flow and for the most part you're seeing not the case. You know no outcomes based medicine. There are institutions out there doing it but you're just surprised by all these things that are really not working the way that you felt they should be. Can you give the listeners an example of what JOMI is doing your journal to do things differently and improve outcomes.

: [00:06:29] So our goal is to be the window into the practice of high volume top practicing surgeons like for example the most recent article published is a total knee done by Dr. Scott and he's done over 2000 of these procedures. This also serves to preserve knowledge because he has recently retired. And my understanding and the goal of JOMI is to really impact outcomes by creating a bridge to high volume surgeons where that Israel like and where is that relevant. So residency training right. So that's the most natural one. You are a resident you wake up in the morning you're preparing for a case. Wouldn't it be good to be able to watch a case performed by Heibel insert trauma. You don't know what's going to come in necessarily don't have a lot of time to prepare. So we feel trauma to the limits for rare procedures within the local executer repair. That's one in every quarter of a million births. It's very hard to be a Heibel surgeon when it's such a rare condition novel procedures. Right. So we filmed Dr. Einhorn who did a novel approach on how to hernia repair or withheld. Dr. Ratner at Mass General who did his whole minimally invasive procedure that is focused on parole and the Skarbek my army. And it's something where Dr. Ratner is a pioneer. All right now we're just released an article by doctors Nardy. It's a cardiac case, which is pretty fascinating. He mentioned to us that he is using a thoracotomy to do what right now is generally done through a full synonymy. Right. And that's a very different profile for recovery. Right. His patients are out in two days.

: [00:08:33] So what you're saying is JOMI puts together videos high volume surgeons and you share best practices through the video medium in order to help improve outcomes. And you got all these amazing specialties that you've already captured. Kudos to your team you've been able to not only go deep but also abroad in these subjects. Tell us a little bit about maybe who's using you and what kind of an impact it's making on and maybe some success story.

: [00:08:59] Sure sure. So I feel like there are a lot and it's going to be hard to cover cover all of it in the short bit of time but one of the things that we decided to do very differently from the very beginning is most publishers they charge based on access. Right. So you want to access the content you pay me I give you access. What we did is we flipped that I would like to think that we're trailblazing with the idea of value based publishing or value based sales meaning that anyone can access sarkari and all they need to create is create an account and this gives us an incredible view into where we're creating value. So for example when patients create accounts we don't charge them they have enough to worry about. But it's interesting to interact with them and what I don't realize is that preoperative anxiety affects postoperative outcomes. So we've had multiple instances where we had interactions patients who told us like look we watched the procedure and it made us much more comfortable with the case. So thank you for that. We've seen spikes in usage for medical students especially third and fourth years. One case comes to mind where in Israel a medical student discovered us and then shared it with all of his friends. And then we had a spike of a tremendous spike of usage there. And this is an example of continental knowledge transfer where all of a sudden you're far away from Medical's in Israel is not going to be able to travel to Mass General.

: [00:10:24] Right. And that actually leads into rural conflicts and rural areas. Right. Especially like one of the youth kids is in Australia. You have vast distances that you're not able to access training material when you're far away from any major medical center could be tremendously useful. One of my favorite favorite favorite examples is we had one of our Tramore videos taken to Haiti after the tragedy that happened there. Yes. And there is a picture on our blog of a roomful of residents there all of us watching this video and apparently you know the session lasted two hours. This was in 2015 and it was an article by Dr. Weaver Michael Weaver at Brigham and Women's. And it took them two hours to watch our video. And I'm not sure if they actually even emerged and that was an example of right there on the ground having an impact. One of the things that I am trying to push for right now is actually to quantify the impact that we're having to make sure that we're not just you know releasing pretty pictures because I do think it's fair to say that we are probably the premier resource for surgical video right now of the sort. There are a number of other sources of varying quality some of them are pretty good but I think we're the only ones for this systematic and this good from when you talk incision to closure.

: [00:11:50] But the question is What are the outcomes of the research. Are we making a slightly better resource for residents and medical students and attendings you know across bus distances or are we impacting care from an Arkansas perspective in some quantified manner. So Dr. Scott Duke Medical Center who is working with us on the head and neck surgery he's right now is putting together questionnaires to identify how much the videos are helping prepare for cases for residents. We're also right now beginning in collaboration with Howard with general surgery residency there where there's going to be questionnaires that are going to again measure the improvement. And my hope is to eventually work with Char systems and people who understand operations. So for example there is a venture out of the Harvard innovation lab called avant garde health and what they do is they build dashboards for hospitals. Right so if we're able to it's one thing to build a dashboard but then there's an action. Right. So these are the surgeons were able to deliver really great care. These surgeons will need improvement. Now let's go the window to surgeons who are delivering great care and see if there is actually improvement because quite possibly our resources not really brain that much value. And if that's the case I don't really want to be here right.

: [00:13:11] I mean the only when it's you and I'm right I want to measure and your impact.

: [00:13:15] I want to not be full of crap you know like Japan right here. That's every inch of a nurse. Fear is like if I'm investing this much of my heart and soul into this. Yes and I've made such ridiculous sacrifices which you know not to be my chest but I paid a pretty high price to get here especially given that we did not raise money from VCs or corporate in order to maintain our kind of ethos and independence as a message to the listeners.

: [00:13:44] I don't think that words can do justice for the videos and the resources that the folks at JOMI him Nikkita on his team that they've put together. But just go to the Website and it's amazing what these guys have been able to. Guys and gals have been able to capture urology pediatric surgery neurosurgery utter I can't even pronounce it auto oral knowledge allergy theology had a neck trauma. Third the Predix. So if you're a resident working your way into the healthcare space. Take a look at this. If you're just an administrator you know you're an administrative executive and you want to go and you want to do your rounds. You know you want to do your leadership rounding before you go step by the orthopedic surgeons pop up JOMI and check out what those guys are doing get an appreciation for it and then go in there use some terminology that will help you hit it off with them in a good way. The resources that are out there that these guys are creating at JOMI are just phenomenal. And kudos to you Nikita for taking the time and it's just amazing how much content you guys have.

: [00:14:55] Thank you. We're actually so to help your listeners kind of prepare for what we have and kind of addict leaves us. We're very strong and general surgery. We're very strong on orthopedics we're very strong and had that neurosurgery. We have some content. We don't have a lot of content yet. Right now we're at a stage where we're growing significantly. And for listeners, your goal is very simple. Joe Mediacorp J. And I love it.

: [00:15:22] You guys have a lot of exciting things. So Enokida at this point I want to do a little thing we're going to pretend you and I are putting together a medical leadership course on what it takes to be successful in medicine. The 101 course or the ABC is of Nikita Bernstein. So what I'd like to do is take an outsider's perspective on this and be really fun to do with you. And so what would you think the best way to improve healthcare outcomes is I need to be very careful to your listeners.

: [00:15:51] I don't know what I'm doing with certain extent in health. Like I'm a complete outsider so please please please take what I say with a grain of salt. Not that you would do otherwise but I really am very naive about these things which does give me a different viewpoint. I apologize if anything I say comes off as stupid. So that being said it feels like the most important thing in this day and age is focus on outcomes. It is collection of data sharing of data and then acting on that data to the H.R. providers. I think it's really important to ensure that API eyes are available so that there are players that can integrate your data into cohorts to help drive decision making. Yes there is all sorts of problems around data quality of the data is collected differently et cetera et cetera. But fundamentally I think what can improve quality of care is two things. One is focus on outcomes and the other is the right. Now I think one of the things that is not being talked about that I think is one of the very important fundamental drivers of change is changing management practices change in business structures. For example the shift from long cycle to short cycle peer based assessments where one of my mentors told me you know you give up power to gain influence. One of the things that I hear quite often in medical contexts is the way that practice happens that teamwork becomes very important. That's the way that people interact becomes very important. And here I think it's very important for especially for administrators to empower the physicians the nurses the practitioners to ensure that there is peer accountability around practice of medicine tying it back again into outcomes.

: [00:17:49] And that's a great message. And so what would you say. The one area of focus should drive the company I can say what drives us a journey.

: [00:17:59] And again we're very particular breed of entrepreneurs. We have a particular equity structure a particular process for recruiting etc.. What drives us is the potential for impact. I think if it turns out that Jeromy is just making pretty pictures most of us will walk away no matter how much money we're making. So I think building the love for the thing you're building allows you to deal with everything else. Right. And certainly within the company we have different loves right some people really love the video production aspect. Some people really love the storytelling aspects and people really love the process of engaging with hospitals and engaging with the community. Some of us I got to confess I mean we get a huge kick out of when people ask us what we do oh yeah we do the best cardiac surgical video in the world and it looks like it really. Yeah. As General and Brigham Women's yeah.

: [00:18:57] Joe McCarthy it is. That's me at camp says you know check it out make overly explicit videos. That's great man.

: [00:19:07] So love for the for the thing I think it's super important with another thing that I think is very important that should be paid attention to is that people should feel that they're being treated fairly and that I think is the one of the things those things in Russia are overexpression a spoonful of tar will ruin a barrel full of honey Higo keeping a and shelter is open culture with a focus on why you are here. Super super important as a driver now.

: [00:19:35] Thank you Nikita. That's a great message. And what book would you recommend to our listeners.

: [00:19:39] I think one of my biggest challenges as I grew and one of the biggest mistakes that I made as an entrepreneur is I used to send really long e-mails especially when I was in disagreement with my partners which now in retrospect was absolutely mad. No wonder I wouldn't have been able to stand in those situations so I think the one book I would really urge anyone entrepreneur not entrepreneur I would really urge people to read. Getting to Yes it's negotiation 101. It's and it's not even negotiation so much as the like dude get out of your head and try to understand why people are doing what they do. What is driving them. Nobody wakes up in the morning to screw other people. I mean I'm sure there are some people who do it right but the majority of people are good people who are just trying to get by and be happy.

: [00:20:33] Right. Right now getting to yes sad. You remember the author Leon Eurus Leon Harris so our contract listeners there you have it. All the things that we discussed in the show. You'll be able to find an outcomes rocket dot com slash Nikkita that's an I.K. Ita and you'll see the show notes links to the book's links to Jeromy dot com archives.

: [00:20:57] I'm so sorry. It is actually not yours. It is Roger Fisher and William Ury.

: [00:21:02] They haven't. So no need to write it down. Just check out the Schoenaerts and you'll be able to find it.

: [00:21:08] Sorry for interrupting.

: [00:21:10] It's OK. Before we conclude can you just share one closing thought and the best place where the listeners can get a hold of me so I will give you two thoughts.

: [00:21:20] The first one is since we're on a podcast. The quality of resources that you use and the ability to deliver care is you know ability to deliver great care is why we're all here. So I would urge all physicians to certainly take a look at what we're doing and to all administrators to ensure that we have a process to assess the impact of resources as you're purchasing them and really understand the quality of care that you're able to deliver vis visa vis the resources that you have and for those who are considering entrepreneurship since I do have a little bit of that perspective you know you only live once. Don't do things that you would regret. And don't not do things that you would regret not doing so. Yeah I love what you do. It's super important and if you're not excited about what you're doing probably time to change course. But if you are in healthcare and you are an entrepreneur I think we all owe it to each other and to the ecosystem to really focus on outcomes because at the end of the day there is little else. You can't really take money to the grave so there's that if you'd like to get in touch with me send an email to Nikkita Ajani dot com that is and I.K. ita Adjaye or am I dot com or you can just send an email to contact the JOMI.com. That's easier and certainly can find me on Twitter on LinkedIn wherever. I'd be delighted to meet anyone in particular I'd be delighted to meet physicians who are interested in working with us either in publishing with us and helping us understand how to distribute our content. And we're also looking right now for position investors who can help us grow. So if you're a physician and you're looking for an interesting initiative to support we would love to have you.

: [00:23:13] Hey Nikkita really appreciate your thoughts here and looking forward to hearing more about what JOMI does and staying in touch. Thanks so much for making the time.

: [00:23:21] Yeah thanks for having me. It's a delight and pleasure.

: [00:23:27] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes resources inspiration and so much more.